The Amplifying Quality of Group Therapy

Although the concept of group therapy is not new to long-term care, the implementation of the Patient Driven Payment Model (PDPM) has ignited renewed interest in its utilization during a skilled stay. From the resource availability to expand restorative nursing programs that allow up to four skilled residents in a group, to the revised group definition under Section O of the RAI manual, it is highly likely the clinician, staff, and patient interaction throughout a stay will reflect an exciting environment of peer motivation and social engagement.  

Prior to PDPM, if a therapy clinician executed a group with skilled residents participating, the group had to be planned for no more nor less than four individuals. Now, when a skilled resident is included in a group, the clinician has the autonomy to mold the size of the group to include anywhere from two to six participants, as appropriate. The psycho-social benefits and opportunity to apply functional carryover techniques within a quality, patient-centered group have not changed.

As noted by CMS and in multiple research studies, the psycho-social benefits of group are varied and include enhanced learning, increased sense of support, decreased depression, and improved motivation. Consider the story of a skilled patient who planned to return home alone. Prior to the event that led to the skilled stay, she participated in social outings once a week and depended heavily on loved ones to drop by for social interaction. Her family and friends encouraged her to “get out more”, but due to a self-perceived burden and a touch of embarrassment over her functional changes, she frequently declined the invitations. Eventually, this unintentional social isolation led to depression, sadness, and declining functional health. In her weakened functional state, she fell and although no fractures or breaks resulted, she did admit to the hospital due to altered mental status, dehydration, and mild malnutrition. Once stabilized, she admitted to a skilled nursing facility with the hope her weakened state could be reasonably reversed for a safe return home. During her stay, she participated in a physical therapy group once a week in addition to her daily individual therapy. Knowing her history, the clinician formulated a peer group identifying patients with similar goals targeting gait and balance, with the knowledge that this patient needed the peer motivation and example for attaining and maintaining her functional gains once she discharged home. During those sessions, the patient was encouraged by the evidence that her story was not unique and allowed her to self-identify the functional and emotional effects of isolation all while achieving her physical therapy goals.

Group therapy presents the unique opportunity for the therapy practitioner or restorative nursing staff to engage the patient during their care journey in novel ways. As a result, success is often amplified due to the underlying qualities inherent within group formats that simply cannot be mirrored in individual treatment sessions.  Whether delivered by restorative aides as part of a nursing program or by therapy clinicians as part of a rehabilitation stay, there is magic in the makeup of a group that is created with patient-centered intention and guided by staff who recognize the benefits of community and teamwork.

HIPAA Privacy Rule Refresher

Refresh your memory with some of the Privacy Rule points below:

  • HIPAA’s Privacy Rule goal is to protect the confidentiality of patient/resident healthcare information.
  • Protected Health Information (PHI) is individually identifiable health information collected from an individual and created or received by a health care provider, health plan, or health care clearing house relating to past, present, or future physical or mental health conditions of an individual.
  • Information is “individually identifiable” when any of the 18 types of identifiers can be used to identify an individual (e.g. name, address, dates such as birth date, account number etc.).
  • The HIPAA Privacy Rule applies to healthcare organizations, healthcare plans, healthcare clearinghouses, and business associates with access to PHI.
  • PHI can be in paper or electronic form, as well as in verbal communications. 
  • Photos and videos of patients/residents are PHI and require documented authorization to take and use.
  • Access to PHI must be restricted to the minimum access needed to accomplish the intended objective.
  • PHI cannot be used or disclosed without documented patient authorization unless it is for any of the following purposes or situations:
    • Use or disclosure to the patient
    • Use or disclosure for treatment, payment, or general healthcare operations
    • Use or disclosure if the individual can agree or object to a disclosure such as a patient bringing a family with them when discussing care with a physician
  • Covered Entities (CE) are required to provide residents/patients with a Notice of Privacy Practices (NPP) to tell how the CE may use and share their health information.
  • Disposal of documents containing PHI must be rendered unreadable.  Shredding is the most common method of disposal.  Before disposal, be sure to follow your organization’s data retention policies.

For more information regarding HIPAA Privacy, visit

Appeals Demonstration and How it Continues to Evolve

Effective May 1, 2019, CMS expanded C2C Innovative Solution’s QIC Telephone Discussion and Reopening Process Demonstration to include providers/suppliers within certain MAC jurisdictions. Under the Demonstration, providers have the opportunity to participate in a recorded telephone discussion that will be included and considered as part of the appeals case file, prior to C2C’s reconsideration decision. In addition, the QIC has the authority to conduct reopenings on previously adjudicated unfavorable claims that are currently pending Administrative Law Judge (ALJ) assignment and/or unfavorable reconsiderations that have been decided by the QIC, but not yet appealed to OMHA.  Participation in the Telephone Discussion Demonstration is voluntary.

C2C will issue a form letter notifying the appellant that the claim has been selected to participate in the Telephone Discussion Demonstration. Participants will be allowed 14 calendar days from the date of the notification letter to respond by returning the forms with the enclosed letter and indicate a desire whether or not participate in this voluntary Telephone Discussion Demonstration.

If the provider concurs with the request to participate in the Telephone Discussion Demonstration, C2C will conduct the telephone discussions and shall be specific in clarifying Medicare policies and requirements, educating the provider/supplier, and identifying any materials, evidence, and/or documentation that would yield a favorable outcome as part of the reconsideration process. Following the telephone discussion, a reconsideration professional at the QIC will conduct the medical or technical review, considering and applying any additional information or supporting documentation that was provided as a result of the telephone discussion. After reviewing all documentation available, the reconsideration professional will issue a decision on the case.

Click here to read on for more information from C2C.

8 Sweet Ways to Love Your Heart

February is Heart Health Month. Here are some of the top ways to keep the heart healthy and happy.

  1. Sleep. Getting at least seven hours of sleep each night has been shown to reduce the amount of calcium build up in our hearts. Get to bed at a reasonable time or let yourself sleep in when you can.
  2. Be less salty. Adults should consume less than six grams of salt per day or about one teaspoon. Check food labels and cut down on added salt to foods and enjoy the natural flavors instead.
  3. Get fruity! (and veggie). Increase your intake of fruits and vegetables as much as possible throughout the day. Giving your body the nutrients it needs can be healing and give you and natural energy boost.
  4. Keep your hands busy. Knitting, quilting, woodworking, scrap-booking and other activities we do with our hands keeps our minds active and also can help reduce our stress levels.
  5. Dance. Saying to “exercise more” sounds like a chore but telling you to “dance” three or four times a week is a cardiovascular activity that will help to improve your strength and stamina as well.
  6. Laugh. When we laugh, stress hormones are reduced, endorphins and T-cells are boosted, and we can get a good ab workout when we have a good belly laugh. Considering all this, laughter actually might be nature’s best medicine.
  7. Stretch it out. Stretching can help improve your balance, strength and flexibility. It also helps reduce stress and can help improve heart health by helping you relax. Do some simple stretches throughout the day to stay nimble and loose.
  8. Eat breakfast. Eating a nutritious breakfast every morning can help maintain a healthy weight and get your metabolism awake for the day. Food is fuel, so eating a heart-healthy meal at the beginning of the day can help kick start a great day!

Credit: A Year of Wellness™,